Therapeutic Benefits of Stem Cells and Exosomes for Sulfur-Mustard-Induced Tissue Damage

Exosomes in the Real World of Medical Aesthetics: A Review

BACKGROUND

Exosomes are cell-derived nanovesicles that transport proteins, nucleic acids, and lipids and play a significant role in almost every physiological process in the human body. They have generated great interest, especially in the field of tissue regeneration. Studies in the last decade support their great regenerating and rejuvenating potential. However, the lack of standardized procedures, limited knowledge regarding their action mechanism, and little clinical evidence impair their implementation and approval in the medical setting. This review aimed to identify published studies and clinical trials using exosomes in human patients for clinical treatments in aesthetic medicine.

MATERIALS AND METHODS

A systematic search was conducted in the PubMed database using the search term "exosomes" and 25 terms related to aesthetic medicine treatments in human patients. Additionally, a search was conducted in the ClinicalTrials.gov database for interventional clinical trials using exosomes for aesthetic treatments in adults 18 to ≥ 65 years of age.

RESULTS

Nine articles were selected after debugging the initial list of published articles in which exosomes were related to Aesthetic Medicine (633 articles). Nine studies were identified from the initial search on ClinicalTrial.gov (104 trials with exosomes).

CONCLUSIONS

There is no doubt about the scientific basis of exosome regenerative potential and the growing interest in exosomes in Aesthetic Medicine. However, companies must spend more on research to develop standardized and reliable procedures to obtain exosomes for their approval and application in clinical practice.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . This review highlights the large amount of published research on exosomes related to aesthetic medicine and, at the same time, the lack of products approved by regulatory agencies. Several issues have been suggested to elucidate a response, such as the need for standardized protocols and more knowledge to ensure safe treatments. It also highlights the few clinical trials conducted to evaluate exosome properties in aesthetic medicine treatments.

The c-Fos/AP-1 inhibitor inhibits sulfur mustard-induced chondrogenesis impairment in zebrafish larvae

Sulfur mustard (SM, dichlorodiethyl sulfide) is a potent erosive chemical poison that can cause pulmonary lung, skin and eye disease complications in humans. Currently, there is no designated remedy for SM, and its operation's toxicological process remains unidentified. This work employed zebrafish as a model organism to investigate the toxic manifestations and mechanisms of exposure to SM, aiming to offer novel insights for preventing and treating this condition. The results showed that SM caused a decrease in the survival rate of the zebrafish larvae (LC50 = 2.47 mg/L), a reduction in the hatching rate, an increase in the pericardial area, and small head syndrome. However, T-5224 (a selective inhibitor of c-Fos/activator protein) attenuated the reduction in mortality (LC50 = 2.79 mg/L), the reduction in hatching rate, and the worsening of morphological changes. We discovered that SM causes cartilage developmental disorders in zebrafish larvae. The reverse transcription-quantitative polymerase chain reaction found that SM increased the expression of inflammation-related genes (IL-1β, IL-6, and TNF-α) and significantly increased cartilage development-related gene expression (fosab, mmp9, and atf3). However, the expression of sox9a, sox9b, and Col2a1a was reduced. The protein level detection also found an increase in c-fos protein expression and a significant decrease in COL2A1 expression. However, T-5224,also and mitigated the changes in gene expression, and protein levels caused by SM exposure. The results of this study indicate that SM-induced cartilage development disorders are closely related to the c-Fos/AP-1 pathway in zebrafish.

Exosomes isolated from TNF-α-treated bone marrow mesenchymal stem cells ameliorate pelvic floor dysfunction in rats

Exosomes derived from bone marrow-derived mesenchymal stem cells (BMSCs) can alleviate the symptoms of pelvic floor dysfunction (PFD) in rats. However, the potential therapeutical effects of exosomes derived from BMSCs treated with tumour necrosis factor (TNF)-α on the symptoms of PFD in rats are unknown. Exosomes extracted from BMSCs treated with or without TNF-α were applied to treat PFD rats. Our findings revealed a significant elevation in interleukin (IL)-6 and TNF-α, and matrix metalloproteinase-2 (MMP2) levels in the vaginal wall tissues of patients with pelvic organ prolapse (POP) compared with the control group. Daily administration of exosomes derived from BMSCs, treated either with or without TNF-α (referred to as Exo and TNF-Exo), resulted in increased void volume and bladder void pressure, along with reduced peak bladder pressure and leak point pressure in PFD rats. Notably, TNF-Exo treatment demonstrated superior efficacy in restoring void volume, bladder void pressure and the mentioned parameters compared with Exo treatment. Importantly, TNF-Exo exhibited greater potency than Exo in restoring the levels of multiple proteins (Elastin, Collagen I, Collagen III, IL-6, TNF-α and MMP2) in the anterior vaginal walls of PFD rats. The application of exosomes derived from TNF-α-treated BMSCs holds promise as a novel therapeutic approach for treating PFD.